US20220240916A1 - Surgical instrument set for use during unilateral biportal endoscopy - Google Patents

Abstract

Disclosed is a method of unilateral biportal endoscopy and a surgical instrument set used in the same. More particularly, the present invention relates to a method of unilateral biportal endoscopy which separately secures a working portal for surgical instruments and an endoscopic portal for an endoscope, thereby providing a more accurate spinal surgery, and to a surgical instrument set which can be effectively applied to the method.

Description

CROSS REFERENCE TO RELATED APPLICATION
• The present application is a divisional of U.S. patent application Ser. No. 15/879,825, filed on Jan. 25, 2018, currently pending, which, in turn, claims priority to Korean Patent Application Nos. 10-2017-0151636 and 10-2018-0008451, filed on Nov. 14, 2017 and Jan. 23, 2018 respectively, the entire contents of which are incorporated herein for all purposes by this reference.
BACKGROUND OF THE INVENTIONField of the Invention
• The present invention relates generally to a method of unilateral biportal endoscopy and a surgical instrument set used in the same. More particularly, the present invention relates to a method of unilateral biportal endoscopy which separately secures a working portal for surgical instruments and an endoscopic portal for an endoscope, thereby providing a more accurate spinal surgery, and to a surgical instrument set which can be effectively applied to the method.
Description of the Related Art
• The human spine consists of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, the sacrum formed of five fused sacral vertebrae, and the coccyx formed of four fused coccygeal vertebrae. Each vertebra is connected to an adjacent vertebra by a set of joints, and there is an intervertebral disc between each vertebra.
• The intervertebral disc lies between adjacent vertebrae and functions to absorb and distribute the loads of the body and impact, as well as functioning to hold the vertebrae together, and functioning to separate the vertebrae from each other such that the size of the intervertebral foramen is maintained and thus the spinal nerve is not compressed.
• When the intervertebral disc is deformed or ruptured and herniates from its normal position, or when the facet joint is damaged or degenerated, or when the vertebrae are deformed and displaced from their normal positions, the nerves passing through the spinal carnal are compressed, causing pain.
• Meanwhile, as a surgical procedure for performing the above-described spinal disease, a conventional incision is a method of making a large incision in a surgical site. Thus, the conventional incision has a high probability of damaging the blood vessels as well as the spinal nerves and muscles, causes a large amount of bleeding, and has a long recovery period.
• In order to solve such a problem, recently, percutaneous stenoscopic lumbar decompression (PSLD), which is a minimally invasive spinal surgical method, has been performed. However, the PSLD itself is a challenging procedure, and an operator may suffer from technical difficulties due to a restricted field of vision despite using a microscope or spinal endoscope as a supplementary device.
• On the other hand, nerve branches entrapped by fibrous adhesion can be treated to some degree by only epidural block or epidural neurolysis in the stage of weak adhesions or mild stenosis.
• However, when the adhesion or stenosis is severe, approach to the intervertebral foramen is difficult with the procedure described above, or even when treatment is performed after approaching to the intervertebral foramen, there is a high possibility that the pain will recur as a treated area becomes clogged again.
• There is percutaneous foraminotomy as the most effective treatment method that can be applied in such circumstances. Percutaneous foraminotomy is a surgical procedure whereby an enlarging device is directly inserted into the intervertebral foramen through the patient's skin, and adhesions or bone spurs compressing nerve branches exiting the intervertebral foramen are removed and thus the pain is resolved, thereby relieving the compression applied to the blood vessels in the intervertebral foramen and improving the blood flow around nerves.
• For such percutaneous foramnotomy, Korean Patent No. 10-1302453 entitled “percutaneous extraforaminotomy with foraminal ligament resection and instrument tools being used for the same” is disclosed.
• A surgical method and a surgical instrument introduced in the document of the related art is used for securing a single pathway extending to a surgical site and expanding the intervertebral foramen by removing fibrous adhesion, etc. which block the intervertebral foramen, and is configured such that a trocar and a cannula that secure a pathway extending to a target point, an end mill passing through a guide hole of the cannula and having at an end thereof a blade tip, and a curette having a scraping tip inserted into the guide hole and scraping tissue inside the intervertebral foramen.
• However, since the conventional surgical method is performed through a single pathway, a field of vision is poor and operability of the surgical instruments is poor as well. For example, due to a momentary mistake, the blade tip may severely damage normal tissue or touch the blood vessels, causing internal bleeding. Moreover, the surgical instrument is also problematic in that a structure thereof is simple and thus operative effects other than detaching tissue at a target point and scrapping the detached tissue may not occur.
SUMMARY OF THE INVENTION
• Accordingly, the present invention has been made keeping in mind the above problems occurring in the related art, and the present invention provides a method of unilateral biportal endoscopy, which is capable of securing a clear field of vision, thereby enabling accurate identification and removal of lesion and securing high safety. In addition, the method enables minimum invasion with fewer scars and less risk of muscle damage, bleeding, and infection, thereby achieving a rapid therapeutic effect.
• Further, the present invention provides a surgical instrument set used in unilateral biportal endoscopy, which includes a plurality of instruments ergonomically designed to be suitable for each process step in spine surgery, thereby enabling a more efficient surgery.
• In order to achieve the above object, according to one aspect of the present invention, there is provided a method of unilateral biportal endoscopy, the method including: firstly securing pathways for a working portal and an endoscopic portal that extend toward a surgical site in the body of a patient and are distanced from each other; secondarily securing a pathway of additionally securing an access pathway for a surgical instrument and a working space by retracting the muscle inside the secured working portal; inserting the surgical instrument required for surgery into the pathways secured by the firstly and secondarily securing the pathways; inserting an endoscope into the endoscopic portal; performing surgery using the surgical instrument inserted into the working portal while monitoring the surgical site through the endoscope; removing the surgical instrument and the endoscope after the performing the surgery; and suturing entrances of the working portal and the endoscopic portal.
• The firstly securing the pathways may include: marking positions of the entrances of the working portal and the endoscopic portal on the skin of the patient; incising marking portions marked by the marking; inserting an enlarging tube into the body through an incision opened by the incising, thereby forming a pathway extending toward the surgical site; and enlarging the pathway to enlarge a diameter of the pathway by using enlarging tubes having different sizes.
• The secondarily securing the pathway may include: detaching the muscle from the bone at the surgical site; and retracting the muscle detached from the bone through the detaching the muscle and securing the working space.
• The method may further include: supplying a saline solution from outside to the surgical site and discharging materials generated at the surgical site from the body, during the performing the surgery.
• The working portal and the endoscopic portal may be configured such that the entrances thereof are distanced from each other, and the portals may extend into the body to be close to each other such that ends thereof meet with each other at the surgical site.
• According to another aspect of the present invention, there is provided a surgical instrument set used in unilateral biportal endoscopy, the surgical instrument set including: a plurality of enlarging tubes having different diameters and configured to form two separate passageways including a working portal and an endoscopic portal that extend to a surgical site for progression of bidirectional vertebral endoscopic surgery; a muscle detacher detaching the muscle from the bone at the surgical site by being inserted into one of the pathways secured by the enlarging tubes; a muscle retractor retracting the muscle separated from the bone by the muscle detacher and securing an additional working space; and an endoscope inserted into the body through a remaining one of the pathways secured by the enlarging tubes and capturing an image of the surgical site.
• The surgical instrument set may further include a double ended retractor inserted into a space created by the muscle detacher and detaching the nerve root from the bone or ligamentum flavum, the double ended retractor being selectively used during the unilateral biportal endoscopic surgery.
• The surgical instrument set may further include: as an instrument for use when an artificial disc is required to be inserted into a disc space during the unilateral biportal endoscopic surgery, a bone chip cannula provided with a collecting portion collecting and concentrating bone chips supplied from outside, and a guide tube portion connected to the collecting portion and extending in a lengthwise direction thereof, the guide tube portion guiding the bone chips to the disc in a state of reaching the surgical site through one of the pathways; and a bone chip impactor impacting on the bone chips guided to the disc space such that the bone chips are seated in the disc.
• The surgical instrument set may further include any one of: a radiofrequency probe heating and removing a target tissue to be removed located at the surgical site after reaching the surgical site in the body through the working portal secured by the enlarging tubes; a K-punch physically detaching and removing the target tissue to be removed after reaching the surgical site in the body through the working portal; and a round drill grinding necessary bone located at the surgical site after reaching the surgical site in the body through the working portal.
• The radiofrequency probe may include: an insertion rod inserted into the body through the working portal so as to reach the surgical site; an electrode tip provided at a front end of the insertion rod and outputting radiofrequency heat by being applied with electric power from outside; and a safety protrusion formed on a surface of the electrode tip and separating the surface of the electrode tip from tissue to prevent thermal damage thereto.
• The K-punch may include: an entry rod inserted into the body through the working portal so as to reach the surgical site and provided at a front end thereof with a retaining step portion; a slider slidably engaged with the entry rod and moving forward and backward with respect to the retaining step portion; a rotary shaft fixed to a rear side of the entry rod and rotated by manipulation of an operator to control a direction of the retaining step portion; a pushing rod fixed at a front end thereof to the slider and extending from a rear end thereof to a rear side of the rotary shaft; and a handle portion moving the pushing rod forward such that the slider is pressed and moved toward the retaining step portion.
• The round drill may include: an outer tube having a predetermined diameter and extending in a lengthwise direction thereof, the outer tube reaching the surgical site through one of the pathways and having an inclined opening inclined at a front end thereof to have an acute angle with respect to the lengthwise direction of the outer tube; a tube holder fixed to a rear end of the outer tube; and a drill body including a burr exposed to outside of the outer tube and on which diamond powder is distributed.
• The endoscope may be provided with: a hollow tube-shaped guide tube extending in a direction thereof so as to reach at a first end thereof the surgical site in the body through the remaining one of the pathways during use, the guide tube accommodating a probe of an endoscope camera; a saline solution guiding portion provided at a rear end of the guide tube and guiding a saline solution injected from outside into the guide tube, the saline solution guiding portion including a valve body fixed to the rear end of the guide tube and allowing the saline solution injected through an inlet to pass therethrough and move to the guide tube, and a flow control valve provided at the valve body and controlling the saline solution passing through the valve body; and an adapter portion provided at the rear end of the guide tube and guiding the probe of the endoscope camera to the guide tube.
• A damping chamber may be provided between the valve body and the guide tube, the damping chamber receiving and storing the saline solution passing through the valve body and guiding the saline solution to the guide tube.
• A plurality of valve bodies may be provided on an outer circumferential surface of the damping chamber such that a supply amount of the saline solution to the damping chamber is increased.
• The guide tube may be provided on an inner circumferential surface thereof with a linear guide groove extending in the lengthwise direction of the guide tube and guiding the saline solution introduced in the guide tube in the lengthwise direction of the guide tube, such that the saline solution reaches a lens provided at a front end of the probe of the endoscope camera.
• A plurality of linear guide grooves is arranged on the inner circumferential surface of the guide tube in a circumferential direction thereof, wherein a supporting protrusion may be provided between each linear guide groove and an adjacent linear guide groove, the supporting protrusion being in contact with the probe of the endoscope camera.
• The guide tube may be provided at a front end thereof with a projecting portion and a depressed portion that are repeatedly provided in a wave pattern in a circumferential direction of the guide tube and guide the saline solution discharged from the guide tube to flow out in a radial direction of the guide tube.
• The guide tube may be provided with a side slit formed on a side of a front end of the guide tube and discharging the saline solution discharged from the guide tube to a side of the guide tube.
• In the present invention, the method of unilateral biportal endoscopy is capable of securing a clear field of vision, thereby enabling accurate identification and removal of a lesion and securing high safety. In addition, the method enables minimal incision with fewer scars and less risk of muscle damage, bleeding, and infection, thereby achieving a rapid therapeutic effect.
• Further, in the present invention, the surgical instrument set used in unilateral biportal endoscopy includes a plurality of instruments ergonomically designed to be suitable for each process step in spine surgery, thereby enabling a more efficient surgery.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a view showing a basic concept of a method of unilateral biportal endoscopy;
• FIGS. 2A and 2B are views showing a tool kit shown inFIG. 1;
• FIGS. 3A to 3D are perspective views showing a root retractor shown inFIG. 2A;
• FIG. 4 is a view showing a cage guider shown inFIG. 2A;
• FIG. 5 is a perspective view showing a bone chip cannula shown inFIG. 2A;
• FIG. 6 is a view showing an osteotome shown inFIG. 2A;
• FIG. 7 is a perspective view showing a bone chip impactor shown inFIG. 2A;
• FIGS. 8A to 8C are views showing an end plate remover shown inFIG. 2A;
• FIG. 9 is a partial perspective view showing a radiofrequency probe shown inFIG. 1;
• FIG. 10 is a perspective view showing a K-punch shown inFIG. 1;
• FIG. 11 is a perspective view showing a round drill shown inFIG. 1;
• FIG. 12 is a perspective view showing an endoscope shown inFIG. 1;
• FIG. 13 is a cross-sectional view taken along line A-A ofFIG. 12;
• FIG. 14 is a sectional view showing a guide tube shown inFIG. 12; and
• FIG. 15 is a block diagram showing the method of unilateral biportal endoscopy according to an embodiment of the present invention.
DETAILED DESCRIPTION OF THE INVENTION
• Hereinbelow, an exemplary embodiment of the present invention will be described in detail with reference to the accompanying drawings. Throughout the drawings, the same reference numerals will refer to the same or like parts.
• FIG. 1 is a view showing a basic concept of a method of unilateral biportal endoscopy.
• The method of unilateral biportal endoscopy is a method whereby two pathways, that is, an endoscopic portal A and a working portal B perforate a surgical site, a surgical instrument set10 is inserted through the working portal B while anendoscope70 is inserted through the endoscopic portal A, thereby treating the surgical site. In some cases, the surgical instrument may be inserted through the endoscopic portal A while theendoscope70 may be inserted through the working portal B.
• In particular, a saline solution81 is injected through theendoscope70 such that the saline solution is guided to flow through the surgical site, thereby allowing the saline solution to remove residues from the surgical site. The used saline solution is discharged from the body through of the working portal B. As will be described later, theendoscope70 according to the present embodiment functions to visualize an internal surgical site, as well as to guide the saline solution into the body.
• The unilateral biportal endoscopy is characterized in that the surgical instrument and the endoscope approach the surgical site through different pathways, so that a clear field of vision is obtained compared to a conventional method of forming a single incision. Having a clear field of vision is very important factor in spinal surgery.
• In addition, since the surgical instrument does not share a pathway with theendoscope70, a motion of the surgical instrument is relatively free within the pathway, thereby enabling a more efficient surgery.
• The surgical instrument set10 has a very wide range and includes atool kit20 including various types of small tools, aradiofrequency probe40, a K-punch50, around drill60, and theendoscopes70. The components of the surgical instrument set10 are selectively used in accordance with the progress of unilateral biportal endoscopic surgery, and all are ergonomically designed.
• FIGS. 2aand 2bare views showing the tool kit shown inFIG. 1, andFIGS. 3ato 3dare perspective views showing aroot retractor22 shown inFIG. 2a. Further,FIGS. 4 to 8 are views showing the surgical instruments included in thetool kit20.
• As shown in the drawings, thetool kit20 includes an enlargingtube21 for enlarging the size of the working portal B and adilator32 for retaining the enlarged working portal B.
• The enlargingtube21 is an instrument for enlarging the working portal B by being sequentially inserted thereinto by size in order to secure space for allowing entry of other surgical instruments to the working portal B formed at a surgical site during the unilateral biportal endoscopic surgery. In other words, after making a minimal incision in the skin with a scalpel, the enlarging tubes are stepwisely inserted into the incision to enlarge the same.
• The enlargingtube21 has a hollow tube shape having different diameters and lengths. In the present embodiment, the enlargingtube21 is provided as six types ranging from a first enlarging tube21ato a sixth enlarging tube21fhaving different sizes. The first to sixth enlarging tubes21ato21fare selectively used as required.
• The enlargingtube21 may be provided on the outer circumferential surface thereof with a scale (not shown) marked to indicate the depth of insertion. The first enlarging tube21ahas a sharp front end and serves to enlarge the working portal B and the endoscopic portal A immediately after incision with a scalpel.
• Thedilator32 is a bar instrument inserted into the working portal B to retain the working portal B secured by the enlargingtube21. Thedilator32 includes afirst dilator32a, a second dilator32b, a third dilator32c, and afourth dilator32dhaving different sizes as shown in the drawing.
• Adilator core32eis used to enlarge the working portal B and the endoscopic portal A immediately after incision with a scalpel.
• In addition, thetool kit20 further includes a muscle detacher23, a double ended retractor29, aroot retractor22, asuction tip30, an intradiscal irrigator31, acage guider24, a bone chip cannula25, anosteotome26, abone chip impactor27, and anend plate remover28.
• The muscle detacher23 is an instrument for securing an access pathway for an instrument used in the subsequent operation and a working space by detaching muscles from bones at a surgical site in a state of being inserted into the secured incision. In other words, the muscle detacher23 is inserted between the muscle fibers of the fine muscle rather than cutting the muscle. The muscle detacher23 has a blade portion23band a handle portion23a. The blade portion23bhas a soft round shape to minimize the skin wound at the surgical site.
• The double ended retractor29 is an instrument being inserted in the working space created by the muscle detacher23 to detach the nerve root from the bone or the ligamentum flavum or to detach the muscle or ligament.
• The double ended retractor29 is configured such that the angle of tip portions29bprovided at opposite ends thereof are variable, thereby being used for detaching and removing risk factors near the nerves or applying bone wax to a bleeding point during bone bleeding. The tip portion29bis configured such that an angle thereof is in a range of 5 to 25 degrees, and a width varies to 5.5 mm/4 mm/3 mm. The angle and width of the tip29bmay vary.
• The double ended retractor29 is provided at a center thereof with a handle portion29a. The handle portion29amay be provided with a recessed groove for preventing the operator's fingers from slipping or an uneven portion having a predetermined pattern for increasing friction.
• Theroot retractor22 is an instrument for securing a working space and a constant water pressure in the working space by retracting the muscle and providing a pathway that guides the surgical instruments to be inserted and removed therethrough. As shown inFIGS. 3ato 3d, theroot retractor22 is provided at a center thereof with a first curved portion22a, and at an end thereof with a second curved portion22b.
• The first curved portion22ahas a curve angle of about 120 degrees, which is an ergonomically and mechanically ideal angle formed between the surgical instrument inserted and a lesion. In addition, the outer edge of the first curved portion22ahas a semi-tubular shape, and the second curved portion22bhas a shape curved in the same direction as the first curved portion22aor has a half-curved shape to hold the muscle to the nerve root.
• The opposite side of the semi-tubular shaped outer edge of theroot retractor22 may serve as the pathway for insertion or removal of the surgical instruments, which detaches soft tissue such as ligaments, etc., or resects or inserts a disc. Theroot retractor22 may have a width of 4 mm/10 mm and the root retractor having a suitable size suitable according to a surgical site may be selectively used. Theroot retractor22 helps to open and close the working portal B and maintains the working space and water pressure such that an operator can see clear images of the surgical site. In addition, theroot retractor22 serves to control compression and decompression of the nerve root to enable efficient surgery without damaging the nerve root.
• Thesuction tip30 is an instrument for sucking a saline solution injected for surgery or the soft tissue as well as tissue debris generated during surgery. During unilateral biportal endoscopic surgery, a constant pressure is required within the body, and thus a constant pressure (e.g., 30 to 50 mmHg) is maintained using thesuction tip30. Thesuction tip30 can prevent poor visibility of the surgical field from being caused due to the bone, the tissue debris, etc. during surgery.
• Thesuction tip30 includes a handle portion30ato which an outlet is connected and a curve-shaped suction pipe portion30bhaving at a front end thereof a suction hole30c. The suction pipe portion30bmay be configured such that a curve angle thereof is about 130 to 150 degrees, and a diameter thereof is 3 to 5 mm.
• Thesuction tip30 may be used for removing residue, etc. after a space for inserting artificial disc into a disc space is created, or may be used for checking a bleeding site by suctioning a bleeding portion in the peripheral corner of the disc in addition to the disc space.
• Thesuction tip30 can allow the surrounding debris to be discharged before and after insertion of the artificial disc without remaining within the body, and allow the washing area to be accurately ascertained while providing a sufficient field of vision, thereby enabling quick washing and washing water saving.
• The intradiscal irrigator31 includes a handle portion31ahaving awash water inlet31d, and a water tube portion31bcurved at a predetermined angle to secure a field of vision of an operator and having at a front end thereof a discharge hole31c. The water tube portion31bhas a curve angle of about 111 to 130 degrees. When the curve angle is less than 111 degrees, the operator's field of vision is obstructed. Additionally, when the curve angle is greater than 130 degrees, the operator's gaze must be lowered to see the discharge hole31c.
• Thecage guider24 is an instrument for seating a cage (not shown) in the disc space. Thecage guider24 is provided at a first end thereof with a carrying portion24bon which the cage is placed, and at a second end thereof with ahandle portion24a.
• The bone chip cannula25 is an instrument for collecting the bone chips and inserting them into the cage. The bone chip cannula25 includes a funnel-shaped collectingportion25afor concentrating and collecting the bone chips supplied from the outside, and a guide tube portion25bconnected to the collectingportion25aand extending in the lengthwise direction thereof, the guide tube portion25bguiding the bone chips to the disc in a state of reaching a surgical site.
• Theosteotome26 is an instrument for cutting unnecessary bones during surgery. Theosteotome26 is provided at a front end thereof with a cutting blade portion26bcutting the bone, and at an opposite end to the tip end thereof with ahandle portion26a.
• Thebone chip impactor27 is an instrument for impacting on the artificial disc inserted into the disc space or the collected bone material so as to be seated in a precise position. Thebone chip impactor27 is provided at a front end thereof with a tip portion27bbeing in contact with a target to be impacted thereon, and at an opposite end to the tip end thereof with a handle portion27a.
• Further, theend plate remover28 is an instrument for removing the end plate located between the vertebrae and the disc, and is curved at a front end thereof in a hook shape. Since the tip end of the curvedend plate remover28 has a hook shape, each approach to and removal of the end plate located between the vertebrae and the disc is possible. As shown inFIGS. 8a, 8b, and 8c, the tip end of theend plate remover28 may vary in shape.
• FIG. 9 is a partial perspective view showing theradio frequency probe40 shown inFIG. 1.
• Theradiofrequency probe40 is an instrument for heating and removing the soft tissue, disc, epidural fat, and ligaments. While a conventional radiofrequency probe is problematic in that a tip thereof where radiofrequency is generated is in direct contact with a surgical site and thus the surrounding nerve is damaged, theradiofrequency probe40 according to the present invention has a safety protrusion (not shown) whereby no damage to normal tissue is caused.
• Theradiofrequency probe40 includes aninsertion rod40binserted into the body so as to reach a surgical site, an electrode tip40aprovided at a front end of theinsertion rod40band outputting radiofrequency heat by being applied with electric power from outside, and the safety protrusion formed on the surface of the electrode tip40aand separating the surface of the electrode tip40afrom the body tissue to prevent thermal damage.
• In addition, theradiofrequency probe40 may further include an electric power wire supplying electric power to theradiofrequency probe40, and a discharge tube extending from the outside of acasing40cand discharging a saline solution in the body therefrom.
• Moreover, the electrode tip40amay be detachably fitted into theinsertion rod40band includes ashield portion40f. Theshield portion40fis a soft round-shaped member for minimizing damage to the body tissue and facilitating insertion when the electrode tip40ais inserted into the body. Theshield portion40falso serves to block heat of plasma from being transferred to normal tissue.
• FIG. 10 is a perspective view showing the K-punch50 shown inFIG. 1.
• The K-punch50 is an instrument for detaching and removing the bone, ligamentum flavum, soft tissue, etc. and includes anentry rod50a, a slider50c, arotary shaft50d, a pushing rod50f, and a handle portion50e.
• Theentry rod50ais a member being inserted into the body so as to reach a surgical site at a front end thereof, and is provided at the front end thereof with a retaining step portion5b. Further, the slider50cis slidably engaged with a side of theentry rod50aand moves forward and backward with respect to the retainingstep portion50b. The slider50cis pressed and moved to the retainingstep portion50bin a state in which a target to be removed is positioned between the retainingstep portion50band the slider50c, whereby the target to be removed is physically fixed.
• Therotary shaft50dis fixed to the rear side of theentry rod50a, and is rotated by an operator's operation as required during surgery such that the direction of the retainingstep portion50bis controlled. As such, by provision of therotary shaft50d, the handle portion50eis operable at a comfortable angle regardless of the position of tissue to be removed.
• The pushing rod50fis fixed at a front end thereof to the slider50cand extends from a rear end thereof to the rear side of therotary shaft50d, the pushing rod being configured to move forward to press and move the slider50cto the retainingstep portion50bwhen the handle portion50eis manipulated.
• FIG. 11 is a perspective view showing around drill60 shown inFIG. 1.
• Theround drill60 serves to grind unnecessary bone parts during surgery and is used in combination with a separate handpiece (not shown).
• Theround drill60 is provided with an outer tube60ahaving a predetermined diameter and extends in the lengthwise direction thereof, the outer tube60ahaving an inclined opening60binclined at a front end thereof to form an acute angle (e.g., 38 degrees) with respect to the lengthwise direction of the outer tube60a, atube holder60dfixed to a rear end of the outer tube60a, and a burr60cpartially exposed to the outside of the outer tube60athrough the inclined opening60b.
• The inclined opening60bis provided to partially cover the burr60csuch that the burr60cremoves only unnecessary portions without damaging normal tissue and the nerve.
• The burr60cis a cutting tip on which cutting diamond powder is distributed, and types thereof may vary. For example, a round burr, a diamond burr, etc. may be used. Unlike a conventional burr used in endoscopic surgery, the diamond burr is embedded with fine diamond powder. Since fine diamond powder is distributed to serve as a cutting blade, the depth of cutting the bone can be precisely controlled and bleeding can be minimized. In addition, the shape of the burr60cmay be implemented in other shapes such as a triangular pyramid shape as well as a round shape.
• FIG. 12 is a perspective view showing theendoscope70 shown inFIG. 1, andFIG. 13 is a cross-sectional view taken along line A-A ofFIG. 17. Further,FIG. 14 is a sectional view showing theguide tube71ashown inFIG. 17. Theendoscope70 includes asheath mechanism71 and anendoscope camera73.
• Theendoscope camera73 is a device for identifying and capturing an image of a surgical site in the body, and includes a flexible probe73aextending in the lengthwise direction thereof and having an optical fiber cable therein, A lens73bprovided at a front end of the probe73a, and a lens barrel73cprovided at a rear end of the lens73b.
• Theendoscope camera73 may further include an imaging control device for capturing and recording images, a light source connected to a guide cable for illuminating a imaging site, the guide cable for transporting light to a distal end of theendoscope70 for emitting light to the imaging site, and an endoscope tray storing theendoscope camera73 and facilitating movement of theendoscope camera73.
• Thesheath mechanism71 is combined with theendoscope camera73 to constitute asingle endoscope70 and serves to support theendoscope camera73 during surgery whiling secure a field of vision. The reason why thesheath mechanism71 is used is that the probe73aof the endoscope camera is very thin and tends to be curved, and thus the lens73bmay not be allowed to reach a target point in the body. Another important function of thesheath mechanism71 is to guide a saline solution to a target point.
• Thesheath mechanism71 includes aguide tube71a, a damping chamber71m, avalve body71b, and anadapter portion71s.
• Theguide tube71ais a hollow tube-shaped member that extends in the lengthwise direction thereof, and a first end thereof reaches a surgical site in the body when in use. The material of theguide tube71amay vary and may be made of, for example, stainless steel or a synthetic resin including polypropylene.
• The length of theguide tube71amay vary as required. Theguide tube71ais inserted into the body through the portal secured by the enlargingtube21.
• In particular, theguide tube71ais provided on an inner circumferential surface thereof with a plurality of guide grooves71p. The guide grooves71pextend in the lengthwise direction of theguide tube71aand serve to guide a saline solution supplied from the outside to an outlet71f.
• As shown inFIG. 13,linear protrusions71rare provided between the guide grooves71p, respectively. Thelinear protrusions71rare arranged in parallel with the guide grooves71p, and a plurality of the protrusions are arranged in parallel to form the guide grooves71p. Thelinear protrusions71rand the guide grooves71pare arranged in the circumferential direction of theguide tube71ato be distanced from each other at predetermined intervals.
• Additionally, thelinear protrusions71rare in partial contact with an outer circumferential surface of the probe73ainserted into a space portion71nof theguide tube71aand to thereby support the probe73a. The diameter of a virtual cylinder connecting the upper ends of thelinear protrusions71ris greater than the diameter of the probe73a. Thus, the probe73acan move vertically and horizontally in the space portion71nand freely slide in the lengthwise direction thereof.
• Furthermore, theguide tube71ais provided at a front end thereof with a plurality of projecting portions71hand a plurality of depressed portions71g. The projecting portions71hprojects in a direction of the front end of theguide tube71a, that is, in a direction in which a saline solution is discharged, and the depressed portions71gare depressed in a direction opposite thereto. In particular, the projecting portions71hand thedepressed portions71aare repeatedly provided in a wave pattern in the circumferential direction of theguide tube71a.
• The projecting portions71hand thedepressed portions71aserve to guide a saline solution discharged from theguide tube71ato flow out in the radial direction of theguide tube71a. For example, when the front end of theguide tube71ais clogged with the muscle, the saline solution is allowed to be supplied through thedepressed portions71a, or is imparted with directionality for securing a field of vision.
• In addition, theguide tube71ais provided with a side slit71kformed on the side of the front end of theguide tube71a. The side slit71kserves to control the flow direction of a saline solution. In other words, during unilateral biportal endoscopic surgery, the flow direction of the saline solution is controlled, whereby the lens73bis easily cleaned while the saline solution flows by gravity, thereby securing a field of vision of theendoscope70.
• The side slit71kserves as a passage for a saline solution. For example, as mentioned above, the side slit71kis provided to prevent a case where thedepressed portions71aof theguide tube71aare clogged with tissue such as muscle Z and thus the saline solution is not efficiently discharged, and is provided to impart directionality to the saline solution to secure a field of vision.
• The saline solution introduced into theguide tube71ais discharged through the side slit71kby gravity and washes away tissue or blood of the affected area, thereby securing a field of vision.
• Theadapter portion71sserves to maintain a position of theendoscope camera73 with respect to thesheath mechanism71, and has a holder71dfor supporting theendoscope camera73. Theguide tube71ais open at a rear end thereof to the rear side of the holder71d. When the probe73ais fully inserted into theguide tube71athrough the holder71d, theendoscope camera73 is supported by the holder71dand thus is prevented from being separated backward.
• Meanwhile, the damping chamber71mis a space communicating with the rear end of theguide tube71a, and serves to receive a saline solution supplied through aninlet71cand avalve body71b, store the same therein, and transfer the stored saline solution to theguide tube71a.
• By provision of the damping chamber71m, deviation in the flow rate of a saline solution supplied to theguide tube71ais kept as low as possible. When the damping chamber71mis absent, a change in the flow rate of the saline solution supplied through a saline solution supply tube (reference numeral82 inFIG. 1) is immediately reflected in theguide tube71a. The capacity of the damping chamber71mmay vary as required.
• Twovalve bodies71bare provided at the periphery of the damping chamber71m, and each of thevalve bodies71 is provided with aflow control valve71e. Theflow control valve71eserves to control the flow rate of a saline solution passing through thevalve body71band is manipulated by an operator.
• Reference numeral71cdenotes an inlet to which the saline solution supply tube82 is connected. The saline solution having flowed through the saline solution supply tube82 reaches the affected area through theinlet71cvia thevalve body71b, the damping chamber71m, and theguide tube71a.
• FIG. 15 is a block diagram showing the method of unilateral biportal endoscopy according to the embodiment of the present invention.
• As shown in the drawing, the method of unilateral biportal endoscopy according to the present embodiment includes a step of firstly securing pathways S101, a step of secondarily securing a pathway S102, a step of inserting an endoscope S105, a step of inserting a surgical instrument S107, a step of performing surgery S109, a step of removing S111, and a step of suturing S113.
• The step of firstly securing the pathways S101 is a process of forming two pathways extending toward a surgical site in the patient's body, that is, the working portal B and the endoscopic portal A, and includes marking S101a, incising S101b, enlarging tube inserting S101c, and pathway enlarging S101d.
• First, the marking S101 is a process of marking points at which the working portal B and the endoscopic portal A are formed on the skin on the vertebral region of a patient lying in a prone position. In other words, entrances through which an instrument, such as thetool kit20, theradiofrequency probe40, the K-punch50, or theround drill60 from the surgical instrument set is inserted are marked. In particular, two marking points must be distanced from each other. The marking points vary depending on the location of a surgical site. When a lesion is located in a deep position, the distance between the two marking points is increased.
• The working portal B and the endoscopic portal A are independent pathways to each other, and are configured to meet with each other at a lesion site in the body whereas the entrances thereof are separated from each other, thereby forming substantially sides of a triangle.
• When the marking S101ais completed, the incising S101bis performed. For example, the incising S101bis a process of making incisions on marking portions using a scalpel, whereby the entrance through which the enlargingtube21 is inserted is opened. Herein, the incision length may be about 5 mm.
• Subsequently, the enlarging tube inserting S101cis a process of forming a straight pathway toward a surgical site by inserting the enlargingtube21 into the body using the incision opened through the incising S101bas an entrance. Of course, the enlargingtube21 used first is the first enlarging tube21ahaving the smallest diameter.
• The pathway enlarging S101dis a process of enlarging the diameter of the pathway by using enlarging tubes having different sizes. For example, in a state in which the first enlarging tube21ais inserted into the body, the second enlarging tube21bis inserted thereover and then the first enlarging tube21ais taken out. Thereafter, the third enlargingtube21cis inserted over the second enlargingtube21cand then the second enlarging tube21bis taken out in such a manner that the diameter of the pathway is increased.
• The pathway enlarging S101dmay be applied to both the endoscopic portal A and the working portal B. Needless to say, the diameter of the working portal B through which the surgical instrument set is inserted should be relatively large.
• As described above, the endoscopic portal A and the working portal B formed through the step of firstly securing the pathways S101 are distanced from each other on the patient's epidermis but meet with each other at a surgical site in the body.
• Subsequently, the step of secondarily securing the pathway S103 includes muscle detaching S103aand muscle retracting S103b. The muscle detaching S103aincludes a process of detaching the muscle from the bone of a surgical site using the muscle detacher23 described above. In other words, by inserting the muscle detacher23 into the pathway secured through the step of firstly securing the pathways S101 to detach the bone and muscle of the surgical site, an access pathway for the instruments used in the subsequent operation and a working space is secured.
• Further, the muscle retracting S103bis a process of securing an additional working space by retracting the muscle using theroot retractor22 described above. In other words, the muscle separated from the bone is retracted through the muscle detaching S103a, thereby securing a sufficient working space.
• Subsequently, the step of inserting the surgical instrument5107 is a process of inserting the surgical instrument required for surgery through the working portal B secured through the step of secondarily securing the pathway S103. In other words, it is a process of inserting the required surgical instruments according to the progress of surgery. Theradiofrequency probe40, the K-punch50, and theround drill60 as well as thetool kit20 are selectively inserted through the working portal B as required.
• The step of inserting the endoscope5105 is a process of inserting theendoscope70 through the secured endoscopic portal A. Of course, thesheath mechanism71 and the lens73bof theendoscope camera73, which constitute theendoscope70, must reach a lesion site.
• Then, the step of performing the surgery5109 is performed. The step of performing the surgery5109 is a process of performing surgery using the surgical instrument inserted into the working portal B while monitoring a surgical site through theendoscope70.
• The step of performing the surgery5109 is a process of actually performing treatment on a surgical site to be treated in the body. As the treatment progresses, the required surgical instruments are inserted into the body through the working portal B. Of course, a surgery status is continuously monitored through theendoscope70 during surgery.
• In particular, during the step of performing the surgery S109, saline supplying S109ais performed. The saline supplying109ais a process of supplying a saline solution supplied from the outside to a surgical site and discharging materials to be discharged generated during surgery from the body. As described above, the saline solution is guided through theguide tube71aof thesheath mechanism71. The injected saline solution allows debris at a surgical site and tissue removed to be discharged outside.
• Subsequently, the step of removing S111 is a process of removing the used surgical instrument and theendoscope70 from the body. Herein, the surgical instrument may be removed prior to removing theendoscope70. For example, theendoscope camera73 is used to check and identify a surgical site prior to removal thereof.
• When the step of removing S111 is completed, the step of suturing S113 of suturing the entrances of the working portal B and the endoscopic portal A is performed, whereby surgery is completed.
• Although a preferred embodiment of the present invention has been described for illustrative purposes, those skilled in the art will appreciate that various modifications, additions and substitutions are possible, without departing from the scope and spirit of the invention as disclosed in the accompanying claims.

Claims (19)

1-5. (canceled)

6. A surgical instrument set used in unilateral biportal endoscopy, the surgical instrument set comprising:

a plurality of enlarging tubes having different diameters and configured to form two separate passageways including a working portal and an endoscopic portal that extend to a surgical site for progression of bidirectional vertebral endoscopic surgery;

a muscle detacher comprising a blade portion and a handle portion, configured to detach a muscle from bone at the surgical site by being inserted into one of the pathways secured by the enlarging tubes;

a root retractor comprising a first curved portion at a center of the root retractor and a second curved portion at an end of the root retractor configured to retract the muscle separated from the bone by the muscle detacher and to secure an additional working space and a grooved portion having a curvature facing opposite to a direction of curvature of the first curved portion; and

an endoscope configured to be inserted into the body through a remaining one of the pathways secured by the enlarging tubes and to capture an image of the surgical site.

7. The surgical instrument set ofclaim 6, further comprising:

a double ended retractor comprising a handle portion located between two opposite tip portions located at each end of the retractor and configured to be inserted into a space created by the muscle detacher and to detach a nerve root from bone or ligamentum flavum.

8. The surgical instrument set ofclaim 6, further comprising:

a bone chip cannula provided with a collecting portion configured for collecting and concentrating bone chips supplied from outside, and a guide tube portion connected to the collecting portion and extending in a lengthwise direction thereof, the guide tube portion configured to guide the bone chips to a disc in a state of reaching the surgical site through one of the pathways; and

a bone chip impactor comprising a tip portion at a front end and a handle portion at an end opposite of the tip portion configured for impacting on the bone chips guided to a disc space such that the bone chips are seated in the disc.

9. The surgical instrument set ofclaim 6, further comprising:

a radiofrequency probe configured for heating and removing a target tissue located at the surgical site after reaching the surgical site in the body through the working portal.

10. The surgical instrument set ofclaim 9, wherein the radiofrequency probe comprises:

an insertion rod configured for insertion into the body through the working portal so as to reach the surgical site;

an electrode tip provided at a front end of the insertion rod and configured for outputting radiofrequency heat when supplied with electric power; and

a safety protrusion formed on a surface of the electrode tip and configured for separating the surface of the electrode tip from tissue to prevent thermal damage to the tissue.

11. The surgical instrument set ofclaim 20, wherein the K-punch comprises:

an entry rod configured for insertion into the body through the working portal so as to reach the surgical site and having a retaining step portion a front end of the entry rod;

a slider slidably engaged with the entry rod and configured for moving forward and backward with respect to the retaining step portion;

a rotary shaft fixed to a rear side of the entry rod and configured for rotation by manipulation of an operator to control a direction of the retaining step portion;

a pushing rod fixed at aits front end to the slider and extending from a rear end of the slider to a rear side of the rotary shaft; and

a handle portion configured for moving the pushing rod forward such that the slider is pressed and moved toward the retaining step portion.

12. The surgical instrument set ofclaim 21, wherein the round drill comprises:

an outer tube having a predetermined diameter and extending in a lengthwise direction, the outer tube configured for reaching the surgical site through one of the pathways and having an opening inclined at a front end thereof to have an acute angle with respect to the lengthwise direction of the outer tube;

a tube holder fixed to a rear end of the outer tube; and

a drill body including a burr exposed to outside of the outer tube and on which diamond powder is distributed.

13. The surgical instrument set ofclaim 6, wherein the endoscope comprises:

a hollow tube-shaped guide tube extending to reach at a first end thereof the surgical site in the body through one of the pathways during use, the guide tube configured for accommodating a probe of an endoscope camera;

a saline solution guiding portion provided at a rear end of the guide tube and configured for guiding a saline solution injected from outside into the guide tube, the saline solution guiding portion including a valve body fixed to the rear end of the guide tube and allowing the saline solution to pass therethrough and move to the guide tube, and a flow control valve provided at the valve body and configured for controlling the saline solution passing through the valve body; and

an adapter portion provided at the rear end of the guide tube and configured for guiding the probe of the endoscope camera to the guide tube.

14. The surgical instrument set ofclaim 13, wherein a damping chamber is provided between the valve body and the guide tube, the damping chamber configured for receiving and storing the saline solution passing through the valve body and guiding the saline solution to the guide tube.

15. The surgical instrument set ofclaim 14, wherein a plurality of valve bodies is provided on an outer circumferential surface of the damping chamber whereby a supply amount of the saline solution to the damping chamber can be increased.

16. The surgical instrument set ofclaim 13, wherein the guide tube is provided on an inner circumferential surface thereof with a linear guide groove extending in the lengthwise direction of the guide tube and is configured for guiding the saline solution introduced in the guide tube in the lengthwise direction of the guide tube, such that the saline solution reaches a lens provided at a front end of the probe of the endoscope camera.

17. The surgical instrument set ofclaim 16, wherein a plurality of linear guide grooves is arranged on the inner circumferential surface of the guide tube in a circumferential direction thereof, and a supporting protrusion is provided between each linear guide groove and an adjacent linear guide groove, the supporting protrusion being in contact with the probe of the endoscope camera.

18. The surgical instrument set ofclaim 13, wherein the guide tube is provided at a front end thereof with a projecting portion and a depressed portion that are repeatedly provided in a wave pattern in a circumferential direction of the guide tube and are configured to guide the saline solution discharged from the guide tube to flow out in a radial direction of the guide tube.

19. The surgical instrument set ofclaim 13, wherein the guide tube is provided with a side slit formed on a side of a front end of the guide tube and the side slit is configured for discharging the saline solution discharged from the guide tube to a side of the guide tube.

20. The surgical instrument set ofclaim 6, further comprising a K-punch configured for physically detaching and removing target tissue after reaching the surgical site in the body through the working portal.

21. The surgical instrument set ofclaim 6, further comprising a round drill configured for grinding bone located at the surgical site after reaching the surgical site through the working portal.

22. The surgical instrument set ofclaim 6, further comprising a sheath mechanism provided with a guide tube configured to control the direction of a saline solution during the unilateral biportal endoscopy.

23. The surgical instrument set ofclaim 6, wherein the guide tube comprises a plurality of projections and a plurality of depressed portions at a front end which are configured to control the direction of a saline solution during the unilateral biportal endoscopy.

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